HCPCS S0265 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Temporary National Codes (Non-Medicare) Miscellaneous Provider Services |
| Common Place of Service | 11 - Office None 22 - On Campus Outpatient Hospital |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for S0265 |
National average reimbursement for HCPCS S0265 by major payers:
$46.08
$32.61
$30.74
$71.49
HCPCS S0265 vs. Other Miscellaneous Provider Services Codes
The HCPCS S0265 code is part of the Temporary National Codes (Non-Medicare) services used for Miscellaneous Provider Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS S0265 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| S0260-HCPCS | Low | History and physical (outpatient or office) related to surgical procedure (list separately in addition to code for appropriate evaluation and management service) |
| S0265-HCPCS | Low | Genetic counseling, under physician supervision, each 15 minutes |
| S0270-HCPCS | Low | Physician management of patient home care, standard monthly case rate (per 30 days) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S0265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S0265 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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